Kidney Failure

What Is Kidney Failure?

Your kidneys are pair of organs located toward your lower back. One kidney is on each side of your spine. They filter your blood and remove toxins from your body. Your kidneys send toxins to your bladder. Your body later removes toxins during urination.

What causes kidney failure?

In most cases, kidney failure is caused by other health problems that have done permanent damage (harm) to your kidneys little by little, over time.

When your kidneys are damaged, they may not work as well as they should. If the damage to your kidneys continues to get worse and your kidneys are less and less able to do their job, you have chronic kidney disease. Kidney failure is the last (most severe) stage of chronic kidney disease. This is why kidney failure is also called end-stage renal disease, or ESRD for short.

Diabetes is the most common cause of ESRD. High blood pressure is the second most common cause of ESRD. Other problems that can cause kidney failure include:

Sometimes the kidneys can stop working very suddenly (within two days). This type of kidney failure is called acute kidney injury or acute renal failure. Common causes of acute renal failure include:

  • Heart attack
  • Illegal drug use and drug abuse
  • Not enough blood flowing to the kidneys
  • Urinary tract problems

This type of kidney failure is not always permanent. Your kidneys may go back to normal or almost normal with treatment and if you do not have other serious health problems.

Having one of the health problems that can lead to kidney failure does not mean that you will definitely have kidney failure. Living a healthy lifestyle and working with your doctor to control these health problems can help your kidneys work for as long as possible.

           Symptoms

Chronic kidney disease (CKD) usually gets worse slowly, and symptoms may not appear until your kidneys are badly damaged. In the late stages of CKD, as you are nearing kidney failure (ESRD), you may notice symptoms that are caused by waste and extra fluid building up in your body.

You may notice one or more of the following symptoms if your kidneys are beginning to fail:

  • Itching
  • Muscle cramps
  • Nausea and vomiting
  • Not feeling hungry
  • Swelling in your feet and ankles
  • Too much urine (pee) or not enough urine
  • Trouble catching your breath
  • Trouble sleeping

If your kidneys stop working suddenly (acute kidney failure), you may notice one or more of the following symptoms:

  • Abdominal (belly) pain
  • Back pain
  • Diarrhea
  • Fever
  • Nosebleeds
  • Rash
  • Vomiting

Having one or more of any of the symptoms above may be a sign of serious kidney problems. If you notice any of these symptoms, you should contact your doctor right away.

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Kidney failure occurs when your kidneys lose the ability to filter waste from your blood sufficiently. Many factors can interfere with your kidney health and function, such as:

  • toxic exposure to environmental pollutants
  • certain acute and chronic diseases
  • severe dehydration
  • kidney trauma

Your body becomes overloaded with toxins if your kidneys can’t do their regular job. This can lead to kidney failure and even be life-threatening if it’s left untreated.

What Causes Kidney Failure?People who are most at risk for kidney failure usually suffer from one or more of the following causes:

Loss of Blood Flow to the Kidneys

A sudden loss of blood flow to your kidneys can prompt kidney failure. Some diseases and conditions that cause loss of blood flow to the kidneys include:

  • a heart attack
  • heart disease
  • scarring of the liver or liver failure
  • dehydration
  • a severe burn
  • an allergic reaction
  • a severe infection, such as sepsis

Blood pressure and anti-inflammatory medications can also limit blood flow.

Urine Elimination Problems

When your body can’t eliminate urine, toxins build up and overload the kidneys. Some cancers can block the urine passageways. These include prostate (most common type in men), colon, cervical, and bladder cancers. Other conditions can interfere with urination and possibly lead to kidney failure, including:

  • kidney stones
  • an enlarged prostate
  • blood clots within your urinary tract
  • damage to the nerves that control your bladder

Other Causes

Some diseases and conditions may lead to kidney failure, including:

  • a blood clot in or around your kidneys
  • infection
  • an overload of toxins from heavy metals
  • drugs and alcohol
  • vasculitis, which is an inflammation of blood vessels
  • lupus, which is an autoimmune disease that can cause inflammation of many body organs
  • glomerulonephritis, which is an inflammation of the small blood vessels of the kidneys
  • hemolytic uremic syndrome, which involves the breakdown red blood cells following a bacterial infection, usually of the intestines
  • multiple myeloma, which is a cancer of the plasma cells in your bone marrow
  • scleroderma, which is an autoimmune disease that affects your skin
  • thrombotic thrombocytopenic purpura, which is a disorder that causes blood clots in small vessels
  • chemotherapy drugs, which are medications that treat cancer and some autoimmune diseases
  • dyes used in some imaging tests
  • certain antibiotics

Five Types of Kidney FailureThere are five different types of kidney failure:

Acute Prerenal Kidney Failure

Insufficient blood flow to the kidneys can cause acute prerenal kidney failure. The kidneys can’t filter toxins from the blood without enough blood flow. This type of kidney failure can usually be cured once the cause of the decreased blood flow is determined.

Acute Intrinsic Kidney Failure

Acute intrinsic kidney failure can be caused by direct trauma to the kidneys, such as physical impact or an accident. Causes also include toxin overload and ischemia, which is a lack of oxygen to the kidneys. Ischemia may be caused by:

  • severe bleeding
  • shock
  • renal blood vessel obstruction
  • glomerulonephritis, which is an inflammation of the tiny filters in your kidneys

Chronic Prerenal Kidney Failure

When there isn’t enough blood flowing to the kidneys for an extended period of time, the kidneys begin to shrink and lose the ability to function.

Chronic Intrinsic Kidney Failure

This happens when there is long-term damage to the kidneys due to intrinsic kidney disease. Intrinsic kidney disease is caused by a direct trauma to the kidneys, such as severe bleeding or a lack of oxygen.

Chronic Post-Renal Kidney Failure

A long-term blockage of the urinary tract prevents urination, which causes pressure and eventual kidney damage.

Part 4 of 7: Symptoms

What Are the Symptoms of Kidney Failure?Many different symptoms can be signs of kidney failure. No symptoms are present sometimes, but usually someone with kidney failure will see a few signs of the disease. Possible symptoms include:

  • a reduced amount of urine
  • swelling of your legs, ankles, and feet from retention of fluids caused by the failure of your kidneys to eliminate water waste
  • unexplained shortness of breath
  • excessive drowsiness or fatigue
  • persistent nausea
  • confusion
  • pain or pressure in your chest
  • seizures
  • a coma

How Is Kidney Failure DiagnosedThere are several tests that can be used to diagnose kidney failure. These include:

Urinalysis

A urine sample can be tested for any abnormalities, including abnormal protein or sugar that spills into the urine. Your doctor may perform a urinary sediment examination, which will measure the amount of red and white blood cells, look for high levels of bacteria, and search for high numbers of cellular casts.

Urine Volume Measurements

Measuring urine output is one of the simplest tests to help diagnose kidney failure. For example, low urinary output may suggest that kidney disease is due to a urinary blockage, which can be caused by multiple illnesses or injuries.

Blood Samples

Samples of your blood are taken to measure substances that are filtered by your kidneys, such as blood urea nitrogen (BUN) and creatinine (Cr). A rapid rise in their levels may indicate acute kidney failure.

Imaging

Tests such as ultrasounds, MRI, and CT scans provide images of the kidneys themselves, along with the urinary tract. This allows your doctor to look for blockages or abnormalities in your kidneys.

Kidney Tissue Sample

Tissue samples are examined for abnormal deposits, scarring, or infectious organisms. A kidney biopsy is used to collect the tissue sample. A biopsy is a simple procedure that’s performed, usually while you’re awake. A local anesthetic is used to eliminate any discomfort. The sample is collected with a biopsy needle inserted through your skin and down into the kidney. X-ray or ultrasound equipment is used to locate the kidneys and assist the doctor in guiding the needle.When blood flows to the kidney, sensors within specialized kidney cells regulate how much water to excrete as urine, along with what concentration of electrolytes. For example, if a person is dehydrated fromexercise or from an illness, the kidneys will hold onto as much water as possible and the urine becomes very concentrated. When adequate water is present in the body, the urine is much more dilute, and the urine becomes clear. This system is controlled by renin, a hormone produced in the kidney that is part of the fluid and blood pressure regulation systems of the body.Renal failure, also known as kidney failure or renal insufficiency, is a medical condition in which the kidneys fail to adequately filter waste products from the blood.[1] The two main forms are acute kidney injury, which is often reversible with adequate treatment, and chronic kidney disease, which is often not reversible. In both cases, there is usually an underlying cause.

Kidney failure is mainly determined by a decrease in glomerular filtration rate, which is the rate at which blood is filtered in the glomeruli of the kidney. The condition is detected by a decrease in or absence of urine production or determination of waste products (creatinine or urea) in the blood. Depending on the cause, hematuria (blood loss in the urine) and proteinuria (protein loss in the urine) may be noted.

In kidney failure, there may be problems with increased fluid in the body (leading to swelling), increased acid levelsraised levels of potassiumdecreased levels of calciumincreased levels of phosphate, and in later stages anemia. Bone health may also be affected. Long-term kidney problems are associated with an increased risk of cardiovascular disease.[2]

Acute kidney injury

Acute kidney injury (AKI), previously called acute renal failure (ARF),[3][4] is a rapidly progressive loss of renal function,[5] generally characterized by oliguria (decreased urine production, quantified as less than 400 mL per day in adults,[6] less than 0.5 mL/kg/h in children or less than 1 mL/kg/h in infants); and fluid and electrolyte imbalance. AKI can result from a variety of causes, generally classified asprerenalintrinsic, and postrenal. The underlying cause must be identified and treated to arrest the progress, and dialysis may be necessary to bridge the time gap required for treating these fundamental causes.

Chronic kidney disease

Chronic kidney disease (CKD) can also develop slowly and, initially, show few symptoms.[7] CKD can be the long term consequence of irreversible acute disease or part of a disease progression.

Acute-on-chronic kidney failure

Acute kidney injuries can be present on top of chronic kidney disease, a condition called acute-on-chronic kidney failure (AoCRF). The acute part of AoCRF may be reversible, and the goal of treatment, as with AKI, is to return the patient to baseline kidney function, typically measured by serum creatinine. Like AKI, AoCRF can be difficult to distinguish from chronic kidney disease if the patient has not been monitored by a physician and no baseline (i.e., past) blood work is available for comparison.

Signs and symptoms

Symptoms can vary from person to person. Someone in early stage kidney disease may not feel sick or notice symptoms as they occur. When kidneys fail to filter properly, waste accumulates in the blood and the body, a condition called azotemia. Very low levels of azotaemia may produce few, if any, symptoms. If the disease progresses, symptoms become noticeable (if the failure is of sufficient degree to cause symptoms). Kidney failure accompanied by noticeable symptoms is termed uraemia.[8]

Symptoms of kidney failure include the following:[8][9][10][11]

  • High levels of urea in the blood, which can result in:
    • Vomiting and/or diarrhea, which may lead to dehydration
    • Nausea
    • Weight loss
    • Nocturnal urination
    • More frequent urination, or in greater amounts than usual, with pale urine
    • Less frequent urination, or in smaller amounts than usual, with dark coloured urine
    • Blood in the urine
    • Pressure, or difficulty urinating
    • Unusual amounts of urination, usually in large quantities
  • A buildup of phosphates in the blood that diseased kidneys cannot filter out may cause:
  • A buildup of potassium in the blood that diseased kidneys cannot filter out (called hyperkalemia) may cause:
    • Abnormal heart rhythms
    • Muscle paralysis[12]
  • Failure of kidneys to remove excess fluid may cause:
    • Swelling of the legs, ankles, feet, face and/or hands
    • Shortness of breath due to extra fluid on the lungs (may also be caused by anemia)
  • Polycystic kidney disease, which causes large, fluid-filled cysts on the kidneys and sometimes the liver, can cause:
    • Pain in the back or side
  • Healthy kidneys produce the hormone erythropoietin that stimulates the bone marrow to make oxygen-carrying red blood cells. As the kidneys fail, they produce less erythropoietin, resulting in decreased production of red blood cells to replace the natural breakdown of old red blood cells. As a result, the blood carries less hemoglobin, a condition known as anemia. This can result in:
    • Feeling tired and/or weak
    • Memory problems
    • Difficulty concentrating
    • Dizziness
    • Low blood pressure
  • Normally, proteins are too large to pass through the kidneys, however, they are able to pass through when the glomeruli are damaged. This does not cause symptoms until extensive kidney damage has occurred,[13] after which symptoms include:
    • Foamy or bubbly urine
    • Swelling in the hands, feet, abdomen, or face
  • Other symptoms include:

Causes

Acute kidney injury

Acute kidney injury (previously known as acute renal failure) – or AKI – usually occurs when the blood supply to the kidneys is suddenly interrupted or when the kidneys become overloaded with toxins. Causes of acute kidney injury include accidents, injuries, or complications from surgeries in which the kidneys are deprived of normal blood flow for extended periods of time. Heart-bypass surgery is an example of one such procedure.

Drug overdoses, accidental or from chemical overloads of drugs such as antibiotics or chemotherapy, may also cause the onset of acute kidney injury. Unlike chronic kidney disease, however, the kidneys can often recover from acute kidney injury, allowing the patient to resume a normal life. People suffering from acute kidney injury require supportive treatment until their kidneys recover function, and they often remain at increased risk of developing future kidney failure.[15]

Among the accidental causes of renal failure is the crush syndrome, when large amounts of toxins are suddenly released in the blood circulation after a long compressed limb is suddenly relieved from the pressure obstructing the blood flow through its tissues, causing ischemia. The resulting overload can lead to the clogging and the destruction of the kidneys. It is a reperfusion injury that appears after the release of the crushing pressure. The mechanism is believed to be the release into the bloodstream of muscle breakdown products – notably myoglobinpotassium, and phosphorus – that are the products of rhabdomyolysis (the breakdown of skeletal muscle damaged by ischemic conditions). The specific action on the kidneys is not fully understood, but may be due in part to nephrotoxic metabolites of myoglobin.

Chronic kidney disease

Chronic kidney disease (CKD) has numerous causes. The most common causes of CKD are diabetes mellitus and long-term, uncontrolled hypertension.[16] Polycystic kidney disease is another well-known cause of CKD. The majority of people afflicted with polycystic kidney disease have a family history of the disease. Other genetic illnesses affect kidney function, as well.

Overuse of common drugs such as ibuprofen, and acetaminophen (paracetamol) can also cause chronic kidney damage.[17]

Some infectious diseases, such as hantavirus, can attack the kidneys, causing kidney failure.[18]Acute kidney failure occurs when your kidneys suddenly become unable to filter waste products from your blood. When your kidneys lose their filtering ability, dangerous levels of wastes may accumulate, and your blood’s chemical makeup may get out of balance.

Acute kidney failure — also called acute renal failure or acute kidney injury — develops rapidly over a few hours or a few days. Acute kidney failure is most common in people who are already hospitalized, particularly in critically ill people who need intensive care.

Acute kidney failure can be fatal and requires intensive treatment. However, acute kidney failure may be reversible. If you’re otherwise in good health, you may recover normal or nearly normal kidney function.Sometimes kidneys are no longer able to filter and clean blood. This can cause unsafe levels of waste products to build up. This is known as kidney (or renal) failure. Unless it is treated, this can cause death.

What are Kidneys?

The kidneys are 2 bean-shaped organs, each about the size of a fist. They are found in your back on either side of the spine. Healthy kidneys clean waste products from the blood by making urine. They also balance the amount of certain elements in your blood (such as sodium, potassium, and calcium), and make hormones that control blood pressure and red blood cells.

Female Urinary Tract
Medical Illustration Copyright © 2015 Nucleus Medical Media, All rights reserved

What is Kidney Failure?

Kidney (renal) failure is when kidneys don’t work as well as they should. The term “kidney failure” covers a lot of problems. These problems can result in kidney failure:

Male Urinary Tract
Medical Illustration Copyright © 2015 Nucleus Medical Media, All rights reserved

  • Your kidney doesn’t get enough blood to filter
  • Your kidney is hurt by a disease like
    • high blood sugar (diabetes)
    • high blood pressure
    • glomerulonephritis (damage to the kidney’s tiny filters)
    • polycystic kidney disease
  • Your kidney is blocked by a kidney stone or scar tissue
 
 
  •  

 

 

Kidneys are also the source of erythropoietin in the body, a hormone that stimulates the bone marrow to make red blood cells. Special cells in the kidney monitor the oxygen concentration in blood. If oxygen levels fall, erythropoietin levels rise and the body starts to manufacture more red blood cells.

  • Kidneys are the organs that help filter waste products from the blood. They are also involved in regulating blood pressure, electrolyte balance, and red blood cell production in the body.
  • Symptoms of kidney failure are due to the build-up of waste products in the body that may cause weakness,shortness of breath, lethargy, and confusion. Inability to remove potassium from the bloodstream may lead to abnormal heart rhythms and sudden death. Initially kidney failure may cause no symptoms.
  • There are numerous causes of kidney failure, and treatment of the underlying disease may be the first step in correcting the kidney abnormality.
  • Some causes of kidney failure are treatable and the kidney function may return to normal. Unfortunately, kidney failure may be progressive in other situations and may be irreversible.
  • The diagnosis of kidney failure usually is made by blood tests measuring BUN, creatinine, and glomerular filtration rate (GFR).
  • Treatment of the underlying cause of kidney failure may return kidney function to normal. Lifelong efforts to control blood pressure and diabetesmay be the best way to prevent chronic kidney disease and its progression to kidney failure. As we age kidney function gradually decreases over time.Image result for kidney failureImage result for kidney failureImage result for kidney failure

There are several tests that can be used to diagnose kidney failure. These include:

Urinalysis

A urine sample can be tested for any abnormalities, including abnormal protein or sugar that spills into the urine. Your doctor may perform a urinary sediment examination, which will measure the amount of red and white blood cells, look for high levels of bacteria, and search for high numbers of cellular casts.

Urine Volume Measurements

Measuring urine output is one of the simplest tests to help diagnose kidney failure. For example, low urinary output may suggest that kidney disease is due to a urinary blockage, which can be caused by multiple illnesses or injuries.

Blood Samples

Samples of your blood are taken to measure substances that are filtered by your kidneys, such as blood urea nitrogen (BUN) and creatinine (Cr). A rapid rise in their levels may indicate acute kidney failure.

Imaging

Tests such as ultrasounds, MRI, and CT scans provide images of the kidneys themselves, along with the urinary tract. This allows your doctor to look for blockages or abnormalities in your kidneys.

Kidney Tissue Sample

Tissue samples are examined for abnormal deposits, scarring, or infectious organisms. A kidney biopsy is used to collect the tissue sample. A biopsy is a simple procedure that’s performed, usually while you’re awake. A local anesthetic is used to eliminate any discomfort. The sample is collected with a biopsy needle inserted through your skin and down into the kidney. X-ray or ultrasound equipment is used to locate the kidneys and assist the doctor in guiding the needle.There are several treatments for kidney failure, but the type of treatment needed will vary depending on the reason for your kidney failure. Your doctor can help you determine the best treatment option, which may include:

Dialysis

Dialysis filters and purifies the blood using a machine. It performs the function of the kidneys. Depending on the type of dialysis, you may be connected to a large machine or a portable catheter bag. A low-potassium, low-salt diet is often prescribed along with dialysis.

Dialysis doesn’t cure kidney failure, but it will extend your life if you go to regularly scheduled treatments.

Kidney Transplant

Another treatment option is a kidney transplant, but there’s usually a long wait to receive a donor kidney that’s compatible with your body. The advantages to a transplant are that the new kidney can work perfectly, and dialysis is no longer required. The disadvantage is that immunosuppressive drugs must be taken after the surgery. These drugs have their own side effects, some of which are serious. Also, transplant surgery may fail and may even be life-threatening.

Preventing Kidney FailureThere are steps you can take to reduce your risk of kidney failure.

Follow the directions for over-the-counter medications. Taking doses that are too high (even of common drugs such as aspirin) can create high toxin levels in a short amount of time, which can overload your kidneys. Whenever possible, you should limit your exposure to chemicals, such as household cleaners, tobacco, pesticides, and other toxic products.

Many kidney or urinary tract conditions lead to kidney failure when they’re not managed properly. Follow your doctor’s advice, always take prescribed medicine as directed, and maintain a healthy lifestyle.

Treatment of kidney failure

If you have ESRD, you will need dialysis or a kidney transplant to survive. There is no cure for ESRD, but many people live long lives while having dialysis or after having a kidney transplant.

There are many options for treating kidney failure, including kidney transplant and several types of dialysis. Your doctor can help you figure out which treatment is best for you. Learn more about the treatment options for kidney failure.

        Adjusting to kidney failure

Learning that you have kidney failure can come as a shock, even if you have known for a long time that your kidneys were not working well. Having to change your lifestyle to make time for your treatments can make coping with this new reality even harder. You may have to stop working or find new ways to exercise. You may feel sad or nervous. All is not lost. You can get help to feel better and have a fulfilling life. Learn more about adjusting to living with kidney failure.

Complications of kidney failure

Your kidneys do many jobs to keep you healthy. Cleaning your blood is only one of their jobs. They also control chemicals and fluids in your body, help control your blood pressure and help make red blood cells. Dialysis can do only some, not all, of the jobs that healthy kidneys do. Therefore, even when you are being treated for kidney failure, you may have some problems that come from having kidneys that don’t work well. Learn more about the complications of kidney failure.

Disaster preparedness

We can’t always predict when something will happen to derail our treatment plans. There are some simple steps you can take to make sure you are prepared and have access to the things you need to stay healthy in the event of a disaster. Learn more about being prepared for a disaster if you are living with kidney failure.

Kidney failure/ESRD diet

Dialysis helps to do some of the work that your kidneys did when they were healthy, but it cannot do everything that healthy kidneys do. Therefore, even when you are on dialysis, you will need to limit what and how much you eat and drink. Your diet needs may depend on the type of dialysis you are on (hemodialysis or peritoneal dialysis) and your treatment schedule.Learn more about the diet for living with kidney failure.

Generally, treatment for abdominal pain depends upon its cause.

  • Treatment usually is with medications for inflammation ofGastroesophageal reflux disease (GERD)or Ulcers
  • Use antibiotics in case of infections
  • Modify your eating habits
  • Surgical treatment is indicated in conditions likeappendicitis  or hernia (inguinal and umbilical)  

Seek doctors advice before going in for any treatment.

Reference: www.nlm.nih.gov

 

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